Early disease detection and therapy

ABSTRACT

A method for early stage pathology detection, location, imaging, evaluation, and treatment of cells and/or extracellular vesicles in the circulation.

This application claims priority to U.S. Ser. No. 62/303,219 filed Mar. 3, 2016 and expressly incorporated by reference herein in its entirety.

A method for early detection of pathologies such as cancer or metabolic disorders by detecting and evaluating metabolic markers and early stage cells in the retinal circulation. The inventive method renders blood cellular compositions and components indirectly visible and quantifiable by various imaging modalities. This provides means of early disease detection, diagnosis, and treatment.

The retinal circulation stems from the central retinal artery, which is the first branch of the internal carotid artery. The central retinal artery enters the optic nerve 4 mm-5 mm behind the eyeball, and divides into four branches at the optic nerve head, further branching to vascularize the four retinal quadrants.

Retinal tissue is transparent. The retina thus permits visualization and provides a window into the invisible internal circulation. Taking advantage of retinal transparency thus provides an opportunity for unhindered visualization and examination of, among other components, the composition of blood. As one example, cell types and the metabolic state of cells, among other features, can be determined. More specifically, photoacoustic technology permits examination, at the molecular level, of cellular analyte type and concentration, e.g., oxygen, carbon dioxide, sugar, etc. As another example, free circulating tumor cells (CTC) and extracellular vesicles (ECV) such as exosomes can be visualized, assessed, quantified, etc.

Malignant tumors have the capability to metastasize at an early stage, even before the tumor has grown to 3 mm-4 mm in diameter, the point at which they are visible by standard imaging techniques such as computed tomography, magnetic resonance imaging, etc. Such small tumors are not space occupying and often do not produce clinical symptoms in patients, even patients having a genetic predisposition to the pathology are often not aware of its development. It is also difficult to diagnose recurrences of a cancer if a tumor has not yet grown to a size that is radiologically visible. In addition, there is often there is no visible indication of tumor cell activity within a tumor mass after, e.g., radiation therapy or at the margin of a resected lesion for a long time. Tumor growth is currently but erroneously considered as the only sign of tumor activity, but there are many examples where metastatic lesions suddenly grow after years while the patient is considered in remission.

The method permits distinction and differentiation between a malignant lesion and a benign lesion. As only one example, the method can differentiate a malignant but early melanoma of the choroid, the vascular layer of the eye, from a benign choroidal nevus.

In use, a blood sample is obtained from a patient suspected to have a pathology. The blood sample is evaluated for signs of tumor activity by analyzing the sample for the presence of various molecular tumor biomarkers, proteins, microDNA, microRNA, enzymes, nucleosomes, extracellular vesicles, free floating tumor cells, etc. In one embodiment, the blood sample is analyzed for the presence of cancer, and/or various disease biomarkers, including cancer biomarkers, as disclosed in co-pending U.S. Ser. No. 14/976,321 filed Dec. 21, 2015 which is expressly incorporated by reference herein in its entirety.

In one embodiment, an antibody to either a specific tumor or a non-specific tumor is generated in vitro or ex vivo using standard techniques known the art. The antibody may be any type, e.g., polyclonal, monoclonal, humanized, aptamers, etc. The generated antibodies are then used to coat nanoparticles including but not limited to quantum dots (QD) nanoparticles, forming functionalized nanoparticles. The antibody-coated functionalized nanoparticles are injected into the patient's circulation, where they target their corresponding tumor cell membrane receptor antigen. Alternatively, the antibody-coated functionalized nanoparticles are injected in the circulation where they target and bind to not only to the sessile site of the tumor, but also target and bind to free circulating tumor cells and their free floating extracellular vesicles (ECV) or exosomes. The user, after waiting for about 1 min to about 8 min for targeting and binding to occur, then uses photoacoustic technology to image the tumor site and/or circulating cells, as previously described in U.S. Ser. No. 14/976,321.

In one embodiment the nanoparticles range in size from about 1 nm to 500 nm, preferably between 1 nm-10 nm. In one embodiment, the nanoparticles range in size from about 1 nm-8 nm, 8 mm-20 nm, 30 nm-50 nm, or 50 nm-900 nm in diameter.

The exact composition of the functionalized nanoparticle, i.e., both the type of nanoparticle(s), and the type of antibody coating the nanoparticles, can be specific for one or many biomarkers for different tumors or tumor types or tumor sets. The nanoparticle can be coated with cell penetrating agents, e.g., cell-penetrating peptide (CPP), activated CPP (ACPP), etc., eliminating a viral carrier that induces an immune response and cannot be administered repeatedly. That is, the inventive method desirably is performed in the absence of a viral carrier.

In one embodiment, the nanoparticles are quantum dots, either alone or in combination with other nanoparticles. As known in the art, quantum dots may be organic, inorganic, synthetic, magnetic, paramagnetic, non-magnetic, nano/microbubble, piezoelectric, etc.; the nanoparticle structure(s) can include a shell, cage, wire, tube, or other configuration, and the shape may be spherical, cylindroid, tube, multi-faceted, etc.; nanoparticle compositions may be gold, silica, iron, iron oxide, zinc, zinc oxide or their composites, cadmium sulfate, quartz and other piezoelectric nanoparticles, lanthanide or other upconverting nanoparticles, i.e., quantum dot nanoparticles that are excited with two photons of a near infrared wavelength or infrared light and emit one photon of higher energy wavelength of blue to red visible wavelengths, copper, nickel, carbon, or graphene located in the core and/or the nanoparticle surface. The composition of the nanoparticle, e.g., gold, iron, iron oxide, etc. may be functionalized with antibody to specific cell membranes and injected into the circulation to adhere to a tumor, e.g. in the eye, skin, mucosa, etc. The nanoparticles may be coated with a radioactive alpha, beta, or gamma emitter molecule to add the effect of radiation therapy to other therapies such as photodynamic therapy (PDT), thermotherapy, chemotherapy (drug release), etc. In one embodiment gold or iron nanoparticles are coated as previously described to seek the desired cells, then low x-ray radiation is applied to the lesion, e.g., neovascular tissue or a tumor such as melanoma, alone or in conjunction with PDT or thermotherapy. In one embodiment gold nanoparticles are coated as previously described and injected into the circulation to attach to the desired cells, then low dose thermal or x-ray radiation or femtosecond laser pulses to a continuous pulse laser are provided to produce free radicals. The free radicals damage walls of endothelial cells, causing a photodynamic effect with free radical and singlet oxygen formation and platelet aggregation and vascular occlusion. This embodiment may be combined with local drug delivery, such antiproliferative agents, anticancer agents, anti-VEGF agents such as cisplatin that enhances formation of reactive oxygen species. This embodiment may be combined with very low dose systemic administration of medication.

In one embodiment, the composition of the circulating elements is differentiated by size, as rendered visible in the retinal circulation and recorded, as further disclosed, by the adherent nanoparticles. As an example, ECV range in size from 100 nm-500 nm, and tumor cells to which nanoparticles adhere typically range in size from 5 microns-20 microns.

In one embodiment, nanoparticles with a specific anti-tumor antibody, upon stimulation, emit light of a specific wavelength that is detectable by fundus photography, angiography, optical coherence tomography (OCT), and/or OCT angiography (OCTA) as subsequently described. This wavelength of emitted light provides information on the origin of the specific sessile or particulate circulating in the blood or other fluids to which the plurality of nanoparticles containing specific tumor antibodies are attached. Each quantum dot nanoparticle, depending on its size and composition after light stimulation, produces a different wavelength of light, which is specific to its size and composition. If the nanoparticle size or composition and the specific antibody coating (e.g. breast cancer) is known prior to administration in the circulation, the quantum dots seek specific membrane antigens to which to adhere. When stimulated by a light beam, they emit a wavelength of light with a specific wavelength (color) that indicates which nanoparticle/antibody is attached to which cells or cell types that have the specific cell membrane receptor, thereby revealing the identity of that circulating cell, exosome, etc. In one embodiment, after stimulation of the quantum dot nanoparticles with various wavelengths of external light, a fluorescein angiography fundus camera records the light emitted by nanoparticles from inside the retinal vessels. These cameras are modified to have specific barrier filters that separate the incoming stimulating light from the quantum dot emitted exiting light. In this embodiment, the different wavelength of light (colors) emitted by the stimulated quantum dot nanoparticles in the retinal vessels function as an optical spectroscopic system that are recorded, indicating the presence of a specific circulating tumor cell and/or ECV in the circulation. This provides a non-invasive method of imaging, and also provides a method of early cancer detection and differentiation based on wavelength differentiation, i.e., optical spectroscopy), which may then be treated by a specific therapy.

In one embodiment, after the nanoparticles have been stimulated with light of different wavelengths, the nanoparticles emit a fluorescent wavelength that is diagnostic for an actively dividing tumor cell. This is based on the principle that the stimulating wavelength of light is different from emitted light from the stimulated quantum dots. This wavelength differentiates the nanoparticles by size; a smaller size produces a blue wavelength, whereas a larger size produces a longer wavelength such as red. Because the nanoparticles are functionalized with one or more specific antibody or antibodies, it thus also differentiates the nanoparticles bound to a cell containing the specific cell membrane antigen to which the nanoparticles are conjugated. Thus, once the nanoparticles are attached to these circulating cells or ECV, the nanoparticles act as a diagnostic for the presence of the tumor from which the cells or the ECV originate, and they can be tracked and counted by the camera's photometer. In one embodiment, performing the method using a plurality of nanoparticles with different sizes and/or compositions and/or different antibody coatings provides a myriad of diagnostic capabilities for diagnosing numerous active tumors, their cellular origin, and their ECVs.

In one embodiment, the retina is radiated, e.g., with focused electromagnetic radiation, or low dose microwave radiation, or radiofrequency radiation, to increase the temperature of the circulating nanoparticles in the retinal and choroidal circulation. Using photoacoustic imaging technology, a photoacoustic spectroscopy of the antibody-coated nanoparticles, attached to the free floating cells or exosomes, is obtained. The free floating cells or exosomes are thus imaged, and the specific lesions are diagnosed in the eye or other body sites, and/or quantified.

In one embodiment, a light beam from a laser is focused continuously on a specific retinal vessel through a contact lens positioned on the cornea of the patient, after application of a topical anesthesia. The ultrasound receiver of the photoacoustic technology system is attached to any of the side of the eye, lid of the eye, or the forehead proximal to the eye. The operator observes the laser beam focused on a retinal vessel while the retina is under observation through a slit lamp microscope. The photoacoustic system is connected to the laser delivery system via a computer. The operator adjusts the photoacoustic system so that it controls, via the computer, the thermal energy delivered by the laser to achieve a photoacoustic or thermoacoustic response, i.e., sound wave, representing a temperature of about 38° C. to 45° C. from the heated nanoparticles. Because the nanoparticles that are circulating in the retinal vessel absorb the laser energy to a greater degree compared to their surrounding milieu or environment, the nanoparticles' thermal expansion produces a photoacoustic sound wave. This photoacoustic sound wave is recorded by the transducer of a photoacoustic unit, indicating the presence of circulating nanoparticle-cell complexes and/or nanoparticle-ECV complexes in the retinal vessel. The larger circulating cells will have more nanoparticles attached to their cell membrane than the ten-times smaller extracellular vesicles, and will appear larger by photoacoustic imaging. Thus, these two structures are differentiated based on their size. The origin of these cells or ECV can be differentiated by the antibody coated used prior to administration of the nanoparticles functionalized to a specific tumor receptor. Using different laser wavelengths as previously described, with the laser focused on the retinal vessel the quantum dot nanoparticles that absorb a specific wavelength and emit at a different wavelength depending on their size, etc. the fundus camera that has a standard fluorescence angiography system is modified so that a photometer or a detector absorbs that presence of different wavelength pulses emitted from the quantum dots as they pass through the laser spot focused on a retinal vessel. This photometer, as other detectors known in the art of optical spectroscopy, converts radiant power into an electrical signal that can be processed, recorded, and displayed. This system thus provides information on the number of light pulses generated, with the color or wavelength indicating the number of cells or ECV recorded at a given time. The emitted color is indicative of the quantum dot that produced it, which in turn indicates its size and the identity of the antibody that coated that size of quantum dot. Because the quantum dots are antibody coated to specific cell membrane receptors, one can determine the number of those circulating cells or tumor cells, or their ECV, that are circulating at a given time.

As previously analyzed, the amplitude of this acoustic response is in direct relationship with the size and the composition of these nanoparticles. The smaller nanoparticles absorb energy faster than the larger nanoparticles and show a higher temperature than the larger nanoparticles. Thus, the smaller nanoparticles expand faster, and produce a photoacoustic sound with higher amplitude and frequency, than larger nanoparticles. Because the nanoparticles are coated with one or more specific antibody or antibodies against the specific cell of interest, e.g. a tumor cell, the origin of the cell type or ECV can be recognized by the photoacoustic unit's processor that differentiates the amplitude and frequency of these sound waves, as in photoacoustic spectroscopy techniques, and separates each group of sounds from each other group of sounds, indicating the number and size of all specifically coated nanoparticles that have passed through the laser spot light.

As an example, functionalized ferric oxide nanoparticles of a certain size can be coated with a specific antibody to a specific tumor, indicating the presence of that specific tumor or other tumors in the body. The groups of nanoparticles, depending upon size, are coated with a different antibody, e.g., those 1 nm-up to 15 nm in diameter are coated with one antibody, and those 15 nm-up to 30 nm in diameter are coated with a second antibody, and those 30 nm-up to 50 nm, 50 nm-up to 100 nm in diameter, 100 nm-up to 200 nm in diameter, 200 nm-up to 300 nm in diameter, 300 nm-up to 400 nm in diameter, 400 nm-up to 500 nm in diameter, up to about 900 nm, etc., are coated with different antibodies for different tumors.

Photoacoustic spectroscopy can quantify and differentiate which tumors have produced an ECV or circulating tumor cell. Results obtained by photoacoustic spectroscopy are compared and validated with results using optical spectroscopy of the cells using quantum dot nanoparticles that emit specific wavelengths of light upon stimulation. Using these results, one can search for the origin of the tumor using a hand-held photoacoustic unit, as described in detail in U.S. Ser. No. 14/976,321 filed Dec. 21, 2015 which is expressly incorporated by reference herein in its entirety.

The origin of these cells or the ECV can be differentiated by the antibody coating used prior to the administration of the functionalized nanoparticles to specific tumor cell receptors. Using different laser wavelength as described above, with the laser focused on the retinal vessel, the nanoparticle that absorbs the specific wavelength and emits another wavelength depending on its size etc., the fundus camera that has a standard fluorescence angiography system is modified so that a photometer absorbs that presence of different wavelength pulses emitted from the nanoparticles as they pass through the laser spot focused on a retinal vessel. This photometer recording acts like an ordinary spectroscope giving information on the number of light pulses generated with what color or wavelength indicating the number of cells or ECV recorded at a given time. The emitted color is indicative of what quantum dot produced it, which in turn indicates its size and which antibody that coated that size quantum dot. Because the quantum dots are antibody coated to specific cell membrane receptors, one can deduct how many of those circulating cells or tumor cells or their ECV circulate at a given time.

The thermal energy, e.g., electromagnetic radiation, focused microwave, radiofrequency, focused ultrasound wave, etc.) is applied and controlled by the photoacoustic system to any lesion to which the antibody-coated nanoparticles, by specific binding of the antibody to that antibody's specific antigen, directs the nanoparticles and to which the nanoparticles . The lesion may be, e.g., in the eye, skin, or other organs, etc. Using the photoacoustic system, the site of the lesion is heated to about 38° C. to 42° C. The photoacoustic system produces a thermal image of the nanoparticles that are attached, via specific antigen-antibody binding, to the specific tumor mass or infected lesion at any site to which the antibody is directed, in e.g., retina, choroid, skin, mucosa, brain, lung, heart, kidney, liver, temporal artery, etc. Through software within the photoacoustic system, a photoacoustic spectroscopy of each the plurality of nanoparticles that are coated with different tumor biomarkers, infective agent, etc. biomarker antibodies can be created, thereby revealing through their specific and known antibody coating the nature of the mass, suspected lesion area, infected tissue, etc. The result thus provides information on the nature or origin of the tumor cells, infective disease, etc.

In one embodiment, nanoparticles of 1 nm-8 nm can be conjugated with an antibody that, after injection into the circulation of eye cavity, target to specific cell receptors, e.g., receptors on leaky new vessels. The inventive method also provides two- or three-dimensional images by OCTA on the delicate small leaking sites of the blood occular barrier in the eye, or spinal cord, or brain, etc. due to the presence of the nanoparticle passing through the broken vessel or new vessel.

In one embodiment, antibodies coating, with cell penetrating agents such as CPP and/or ACPP, etc., inhibitory gene(s) alone or with the CRISPR complex, the nanoparticles are directed to microorganisms, e.g., bacteria, fungi, viruses, parasites, etc. These antibody-coated nanoparticles are injected systemically into the patient. Using the previously described photoacoustic technology, the nanoparticles bind to the corresponding antigens that are present on the free circulating organisms, or may be collected in the tissue of the retina, choroid, or elsewhere, e.g., in the skin. If bacterial antibody-coated nanoparticles are injected into the circulation and accumulate in the eye or skin, the nanoparticles can be heated by the previously described specific laser wavelength, producing a photoacoustic response that can be recorded by a photoacoustic system. This embodiment provides information about the origin of the infection, etc.

Nanoparticle assisted photography, angiography, OCT, OCT angiography (OCTA) is used for detection and therapy of a disease process, e.g., in the eye or elsewhere in the body.

OCT is based on low coherence tomography using light, and captures two-dimensional or three-dimensional images from the light scattered through and in the media through which it propagates. Using ophthalmology as an example because of transparent ocular media, OCT provides information about the anterior segment, the lens and the retina/anterior choroid. OCT has a potential application for imaging skin and its various disorders, and provides information on the thickness and borders of a skin lesion.

OCTA technology can image the retinal/choroidal vessels, vascular abnormalities, and any retinal/choroidal neovascularizations. In OCTA, consecutive B-scan images of the laser light provide a two- or three-dimensional cross-sectional image of tissues, such as the retina, to the limit of light penetration in the tissue. OCTA is based on the algorithm of split-spectrum amplitude decorrelation, which allows visualization of the inner and outer layer of the retinal vasculature and the choriocapillary of both inner and outer retinal vascular plexus and the choroidal capillary layer. OCTA contrasts the images obtained from the static tissue, e.g. retinal tissue, vs non-static tissue such as blood vessels. OCTA decorrelates the signals, using associated software, and presents a three-dimensional image of the retinal vessels and choriocapilaries separately to a depth of about 10 micron below the Bruch's membrane.

Currently available OCTA systems provide an average axial resolution of about 15 micrometer and an average lateral resolution of about 5 microns. However, the resolution of the image is not sufficient to provide a signal from small molecules having a diameter of less than 500 nm-1 micron. Therefore at present, suspensions of, e.g. serum molecules, originating from leaky vessels in the choroid and retina, remain invisible with OCTA and appear as a dark space in OCT images. Using fluorescein angiography (FA), a much older technique, one sees passage of a fluorescein dye through the small discontinuity in the damaged wall of a leaky vessels. In a fluorescein angiography (FA) the dye becomes visible as a stained wall of a damaged vessel, or as a pool of dye collected in the interstitial spaces or cavities of diseased tissue, e.g. retina. Using fluorescein, the collected small molecules of the fluorescein dye remains invisible, or appear as dark spaces in the OCT and OCTA images and/or under the sensory retina. Therefore, OCT or OCTA do not compare well with standard fluorescein angiography in demonstrating leakage from abnormal or neovascular lesions or small defects in the retinal pigment epithelium or abnormal retinal vessels. The abnormal vessels or new vessels result from hypoxia causing adjacent tissues to produce vascular endothelial growth factor (VEGF), inducing neovascularization. Inflammatory diseases directly affect the blood retinal barrier, cause leakage of fluorescein outside the retinal vasculature. Pathologies such as age-related macular degeneration (ARMD), diabetic retinopathy, central serous retinopathy, stroke, etc. all induce damage to the retinal vasculature. In one embodiment, nanoparticles carry antibodies to VEGF to inhibit growth-inducing abnormal vessels or the vascular supply of a tumor.

FA has a number of shortcomings. One shortcoming is that the deeper retinal capillary plexus and radial peripapillary capillary network cannot be seen in FA due to scattering of the incidence light (blue) and reflected fluorescent light, and in the deeper retinal layers. Similarly, the invisibility of the peripapillary network in the FA renders FA not useful for evaluation of the progression of damage to the optic nerve head or retina in patients with glaucoma, etc. FA also has potential side effects such as nausea, vomiting, pruritus, urticaria, pyrexia, thrombophlebitis, and life threatening reactions such as anaphylaxis response, bronchospasm, cardiac arrest, and death. Local tissue necrosis can also occur with extravasation of the dye at the site of the injection. In addition the fluorescin angiogram cannot satisfactorily demonstrate the choroidal vessels well. As a result, the patient must undergo a second minimally invasive procedure, i.e., the so-called indocyanin green angiography, in which an infrared light is used to excite the dye, obtaining a fluorescent infrared wave length for imaging. Indocyanine green angiography has equal if not more side effects than fluorescein angiography, particularly life threatening side effects or death in patients with seafood or iodine allergies. Another problem is that both these dyes clear the circulation within a few minutes, and have no specificity to abnormal endothelial cells. They are also invisible with OCT technology because of their small molecular size. They also have no therapeutic effect on the disease process and are used only as an imaging tool.

The inventive method overcomes these deficiencies. It provides a method of angiography with new fluorescent quantum dot nanostructures. The quantum dots are themselves fluorescent; when stimulated by a specific wavelength of light, they emit a longer wavelength of light (fluorescent light). They act like fluorescein molecules, but are larger in size and their fluorescence does not bleach. In contrast, in fluorescein molecules, fluorescence bleaches and turns itself off beyond a certain time of light exposure. The quantum dots of 1 nm-8 nm can pass through the blood brain barrier at a site of minor discontinuity. As previously described, the cause of the discontinuity may an inflammatory process, abnormal vessels caused by hypoxia, vascular occlusion such as in diabetes or stroke, a neoplastic lesion, an infection, trauma, tumor, etc.

In one embodiment, quantum dot nanoparticles fluoresce, upon exposure to a specific wavelength of laser or diode light, at a specific wavelength with lower energy. Fluorescence or emitted light from the quantum dot nanoparticles passes, without being scattered by the transparent retinal tissue, through an appropriate barrier filter and can be captured by photograph or video camera.

In one embodiment, the light source that excites the nanoparticles, such as an infrared (IR) source, can simultaneously produce an OCT or an OCTA and which can be recorded separately by an OCT unit and software to produce OCT or OCTA images. The light that is generated from the quantum dot nanoparticles can also be separated from that of the OCT unit via an appropriate barrier filter diverted to be imaged by an angiographic camera separately, creating a combined OCT, OCTA, and fluorescent angiogram system. In one embodiment, infrared excitation light and lanthanide group nanoparticles are used because of the advantage of not being seen by the patient's photoreceptors, thus it does not blind the patient as does visible light. In addition, the same light can simultaneously produce the OCT and OCTA images. This unit requires only a simple infrared prism to divert the returning infrared light to the OCT unit, while permitting the emitted visible light coming through from the lanthanide nanoparticles to be picked up by the system's camera.

In one embodiment, the system provides an IR wavelength excitation and near-IR emission for use with nanoparticles of 1 nm up to 150 nm or even larger than 150 nm. The following elements or composites upconvert the light by absorbing two photons of a low energy light beam and upconvert it to one photon of higher energy beam, e.g., infrared to yellow or blue wavelengths, etc.: lanthanide nanoparticles family erbium, thulium, holium Ln, Ti, Ni, Mo, Re, Os, cerium, lanthnum, lutetium, yttrium, scandium, gadolinium fluoride, and lanthnum fluoride, or as a lanthanide rich composite as known in the art having one lanthanide ion from the group of Ce, Nd, ER, etc. in combination with an anion from a halide, phosphate, vanadate etc., or LaAL0ri3/SrTiO3, thulium-doped silica, gadelonium or neodynium complexes such as Nd—Fe—B, or semiconductors CdSe, PbSe, PbS. These nanoparticles upconvert the excitation light, converting two IR photons to a single visible light that can be photographed with a standard fundus camera, or video-angiography can be performed without producing the previously described side effects of fluoresceine or indocyanin green angiography.

In one embodiment, these nanoparticles are coated. The coating may be polymers such as (poly)ethylene glycol (PEG), chitosan, cell penetrating agents such as CPP, ACPP, etc., one part of the binding pair biotin/streptavadin, etc., as well as containing specific or non-specific antibodies to the desired cells. The antibodies seek abnormal vessels, e.g., found in age related macular degeneration or a tumor, and adhere to the vessel walls for subsequent treatment, under an operator's control and observation. The nanoparticles in any of these embodiments are injected in a biocompatible formulation for the various described indications. In one embodiment, coated nanoparticles are functionalized by conjugation with various cytokine antibodies. These cytokine antibodies, when injected into the circulation, attach to cytokine producing cells, e.g., anti-VEGF coated nanoparticles will localized in an area of a retina that is ischemic and thus that produces VEGF, IL-1, etc. The nanoparticles may be conjugated with cell penetrating peptides such as CPP or ACPP, etc. and an inhibitory gene/CRISRP cas9, to inhibit production of VEGF, other genes, siRNA, etc. or conjugated with IL inhibitory medication. Many diseases such as cancer produce an inflammatory environment, and diseases such as Alzheimer's disease or traumatic brain injury produce inflammatory insults. The inventive technology not only demonstrates and images the site of inflammation, but also potentially treats the inflammation with appropriate medication administered with the quantum dot nanoparticles. The system can also be used for an early stage disease process that can be treated, and the results of the treatment can be quantified.

This methodology can demonstrate the presence of the inflammatory biomarkers in some areas, indicating a part of a tissue affected by a pathology such as an infarct, or a disease state such as a neurodegenerative disease, e.g., Alzheimer's disease, infection, an autoimmune response, a genetic disorder, a tumor, etc. This area can be imaged photographically or using X-rays, MRI, CT, PET, etc., or by antibody coated nanoparticle assisted photoacoustic imaging or localized thermotherapy using electromagnetic radiation, RF, microwaves, focused ultrasound, alternating magnetic field, etc., and/or simultaneous drug release from the nanoparticles. In one embodiment, the nanoparticles, e.g., a lanthanide etc., is coated with a thermosensitive polymer such as chitosan and conjugated with an anti-VEGF cell specific antibody that attaches to vascular endothelial cells producing VEGF receptors in the retina or choroidal abnormal vessels or elsewhere in tumor vasculature. One can specifically make these abnormal vessels visible, image them, and treat them with various means such as a laser in the same session or by another source of energy such as microwave, radiofrequency (RF) waves, electromagnetic radiation, or focused ultrasound waves heating the nanoparticles.

In one embodiment, the IR light can also be simultaneously used as in OCT technology to provide an OCTA image of the retina, or as a nanoparticle-assisted angiogram. The angiogram images can be superimposed, by software, on the OCTA or the OCT to show the exact location of the nanoparticle, e.g., in vessels, or in cysts or cavities, or in the subretinal fluid produced by various diseases of the retina and the choroid. In one embodiment, nanoparticles with a size ranging from 1 nm-8 nm can pass through the smallest breaks of the retinal vessels or retinal pigment epithelium, and be visualized during nanoparticle assisted angiography. This beneficially combines two systems, angiography and OCTA, in one instrument.

In one embodiment, nanoparticles ranging in size from 1 nm-8 nm, or from 8 nm-900 nm generate an internal light after excitation and emit visible light. In this embodiment, the emitted wavelength provides better information from deeper structures, or from the optic nerve head, or in the posterior choroidal circulation, with emission wavelengths appearing akin to stars shining in a dark sky. This emission wavelength can be recorded as a photograph or an angiogram. Because this emitted light is generated internal to a tissue and is not reflected, it does not create interference with incoming invisible IR light. It thus can be seen more distinctly than is possible by standard fluorescein angiography. By selection of the nanoparticle composition, such as quantum dot/plasmonic nanoparticles, one can image the deeper structures located in the choroidal circulation than previously possible with simple OCTA. For example, using nanoparticles from one of the coated functionalized lanthanide series, which then emit visible light and can be visualized and recorded, IR light penetrates deep in the choroid and excites those nanoparticles, which can be visualized and recorded. In one embodiment, the nanoparticles are subjected to wavelength from an IR laser to both heat the nanoparticles and release any medication from the thermosensitive coating, such as chitosan, of a nanoparticle , e.g., anti-VEGF, anticancer drugs, antibiotics, anti-inflammatory agents/inhibitory genes, etc. The wavelength also heats abnormal endothelial cells to enhance the effect of anti-VEGF on the abnormal vessels.

In one embodiment, a known photosensitizer, e.g., verteporphin, is conjugated with antibody coated nanoparticles having a thermosensitive polymeric coating such as chitosan. Upon light activation, the nanoparticles simultaneously release a small amount of photosensitizer from the polymeric coating. Subsequently, after release of the photosensitizer, in the presence of oxygen and laser application, singlet oxygen and free radicals are created. This damages the wall of the abnormal vessels, causing platelet aggregation which closes abnormal vessels, beneficially without damaging normal adjacent tissue or creating a systemic response to the photosensitizer. The inventive method thus is an improvement over and is in contrast to original photodynamic therapy that produced side effects after intravenous injection of a large amount of photosensitizer, such as skin burns when the patient was exposed to sunlight, or an allergic response even as severe as shock or death, or tissue necrosis with photosensitizer extravasation. Nanoparticles produce a fluorescent light upon laser irradiation. This can be simultaneously imaged while the desired tissue is treated and the borders of the neovascular tissue or the lesion becomes visible by the attached antibody coated nanoparticles. It is of note that standard photodynamic therapy for abnormal vessels in ARMD or for neoplasms does not provide any information on the borders of the tumor during therapy. Thus, the investigator has to treat the lesion from the memory and not objectively. This led to many recurrences requiring treatment that unnecessarily damaged the overlaying healthy retina, among other drawbacks. The inventive method solves this problem by allowing visualization of tumor borders and simultaneous release of medication.

In one embodiment, passage of the sized nanoparticles from the circulation provides information on the location and the degree of the damage caused by the disease. Lesions as small as one nm or as large as 900 nm can be imaged. For example, if a damaged area of a vessel exceeds 5 microns, erythrocytes will exit the vessels and cause frank bleeding that obscures the bleeding site. Lesions smaller than 2 microns would allow only non-cellular fluid, i.e., serum, to escape, so this would not be visible by standard OCTA. In contrast, functionalized quantum dot nanoparticles can pass through nanosized openings in the vessels, remain attached to damaged cells, and can be visualized for several hours or days at the site. This permits repeat quantum dot assisted OCTA or angiography over many days, following the lesion during a post-operative period non-invasively using the inventive system.

In one embodiment, since the absorption wavelength of the nanoparticle can be matched with the wavelength generated by OCT, it is possible to excite the nanoparticles to fluoresce. The wavelength of the fluorescent light can be matched with the absorption wavelength of the photosensitizer, e.g. amino-levulinic acid etc., to induce singlet oxygen and free radical formation in a tumor, inducing endothelial cell wall damage of the lesion as many times as needed for therapy. If vessel leakage has persisted and requires re-sealing, this can be accomplished by application of minor thermal laser energy that is absorbed by the nanoparticle and that heats the surrounding area. This is helpful in treating the wet form of age-related macular degeneration, one of the major cause of blindness due to abnormal vessel growth and bleeding under the retina, or diabetic retinopathy with macular edema having early or late stage proliferative retinopathy. Alternatively, in the case of an invisible bleeding site, low level X-ray application can be done. In the presence of an antibody-coated nanoparticle of gold or a gold composite, the functionalized gold nanoparticles enhance the local effect of the radiation while protecting other areas. The same technology can be applied to localized cancers, e.g., breast, prostate, brain, lung, etc. One can also easily repeat treatment, if needed, with a radioactive coating of the antibody-coated quantum dot nanoparticles in cancer patients.

In another embodiment, the nanoparticles may be conjugated with cell penetrating agents such as CPP, ACPP, etc. to a gene/CRISPR cas9 complex that can modify the genetic composition of the cells to which the nanoparticles are targeted. Such a cell may have a genetic abnormality, e.g., age-related macular degeneration etc. and, in this embodiment, the functionalized nanoparticles/genes along with CRISPR cas9 are picked up by the targeted cells, and release the gene into the cell upon or after cellular uptake. As one example, a gene to correct the genetic abnormality in retinitis pigmentosa can allow retinal cells to regain sensitivity to light. As another example, a first conjugated gene is from the opsin family, and a second conjugated gene/CRISPR cas9 complex modifies the genetic composition of cells that might have a genetic abnormality such as retinitis pigmentosa, epilepsy, Alzheimer's disease, Parkinson's disease, etc. As another example, the conjugated gene is an opsin family member such as rhodopsin, halorhodopsin, etc. In another embodiment, the antibody-coated nanoparticle containing the conjugated gene/CRISPR cas9 complex to eliminate the tumor producing gene, or having an inhibitory gene, siRNA, etc. is injected intravenously in an eye or elsewhere as needed. In another embodiment, the antibody-nanoparticle is directed to retinal tumor or brain tumor cells, e.g., retinoblastoma or glioma or glioblastoms. After release of the rhodopsin gene/CRISPR cas9 complex from a thermosensitive coating, one can convert these non-excitable cells to light-sensitive tumor cells that response to light by being depolarized. One can apply non-coagulative pulsed laser fora period of time of about 10 min-15 min or more to the tumor. By applying repeated continuous rapid laser pulses under control of a photoacoustic system, as previously described, using an externally located laser or by a fiber optic, the cell membrane of the tumor cells depolarize. As a result, the tumor is rendered permeable to anticancer or other medication that is released from the coating of the nanoparticle, freely diffusable in the tumor cells to damage the tumor cells.

The tumor can be of neuronal origin such as a glioblastoma in the brain or a retinoblastoma in the eye, or an acoustic neuroma or meningioma, or the tumor may be from the spinal cord cells or peripheral nerves. The tumor can be a melanoma of the choroid or a skin melanoma, or the tumor can be of mesenchymal cells or of ectodermal origin. This technique represents a completely new approach of eliminating the tumor cells without burning them or removing them surgically. By choosing functionalized piezoelectric nanoparticles, one can also use ultrasound or focused ultrasound for both cell depolarization and thermotherapy as needed. Because ultrasound travels deep in tissues, it can be used advantageously in deep body or brain tissues. Nanoparticles are coated with a biocompatible coating such as PEG, CPP, ACPP, etc. or thermosensitive polymers such as chitosan that dissolve during laser therapy and releases a medication, e.g. an anti-VEGF antibody and/or any other medication e.g. anticancer agents melphalan etc. useful to treat a tumor such as a retinoblastoma, glioblastoma, medulloblastoma, acoustic neuroma, spinal cord tumor, peripheral nerve tumor, choroidal melanoma, skin melanoma, mesenchymal cell tumor, tumor of ectodermal origin, basal cell carcinoma, squamous cancer, etc., or an anti-melanoma medication such as allovectin-7, decarbazine, or others such as alkylating agents such as nitrogen mustards including mechlorethamine, cyclophosphamide, melphalan, chlorambucil, ifosfamide and busulfan; nitrosoureas including N-nitroso-N-methylurea (MNU), carmustine (BCNU), lomustine (CCNU) and semustine (MeCCNU), fotemustine and streptozotocin; tetrazines including dacarbazine, mitozolomide and temozolomide; aziridines including thiotepa, mytomycin and diaziquone (AZQ); cisplatin and derivatives including cisplatin, carboplatin, and oxaliplatin; and non-classical alkylating agents including procarbazine and hexamethylmelamine; anti-metabolites such as anti-folates including methotrexate and pemetrexed; fluoropyrimidines including fluorouracil and capecitabine; deoxynucleoside analogues including cytarabine, gemcitabine, decitabine, Vidaza, fludarabine, nelarabine, cladribine, clofarabine and pentostatin; and thiopurines including thioguanine and mercaptopurine; anti-microtubule agents such as vinca alkaloids including vincristine and vinblastine, semi-synthetic vinca alkaloids include vinorelbine, vindesine, and vinflunine; taxanes including paclitaxel and docetaxel; topoisomerase inhibitors including irinotecan, topotecan, etoposide, doxorubicin, mitoxantrone, teniposide, novobiocin, merbarone, and aclarubicin; cytotoxic antibiotics including actinomycin, bleomycin, plicamycin, mitomycin, doxorubicin, daunorubicin, epirubicin, idarubicin, pirarubicin, aclarubicin, and mitoxantrone, etc. to treat melanoma of the choroid or a skin lesion, such as basal cell carcinoma or squamous carcinoma of the skin, etc.

In one embodiment, the antibody coated nanoparticles are coated with an immune checkpoint inhibitor to facilitate leukocyte mediated tumor destruction. Immune checkpoint inhibitors include, but are not limited to, monoclonal antibodies that target either PD-1 or PD-L1 including pembrolizumab (KEYTRUDA®) and nivolumab (OPDIVO®), monoclonal antibodies that target CTLA-4 such as ipilimumab (YERVOY®), and monoclonal antibodies directed against at least one of CD27, CD28, CD40, CD122, CD137, OX40 (also termed CD134), GITR (glucocorticoid-induced TNFR family related gene), ICOS (inducible T-cell costimulatory also termed CD278), A2AR (adenosine A2A receptor), B7-H3 (also termed CD276), B7-H4 (also termed VTCN1), BTLA (B and T lymphocyte attenuator also termed CD272), CTLA-4 (cytotoxic T-lymphocyte-associated protein 4 also termed CD152), IDO (indoleamine 2,3-dioxygenase), KIR (killer-cell immunoglobulin-like receptor), LAG3 (lymphocyte activation gene-3), PD-1 (programmed death 1), PD-L1 (programmed death ligand 1), TIM-3 (T-cell immunoglobulin domain and mucin domain 3), VISTA (V-domain Ig suppressor of T cell activation), and other to be developed.

In one embodiment, the nanoparticles are heated by the same laser that is used to create a fluorescent response, or by another laser producing a wavelength that is absorbed by the nanoparticles to heat them preferentially over the surrounding tissue, e.g., retina or choroid. The nanoparticle temperature is heated to about 43° C., which is below the thermal pain threshold sensation. This heats and thus damages tumor cells by the method previously described in U.S. Pat. No. 8,210,184 which is expressly incorporated by reference herein in its entirety.

In one embodiment, thermotherapy is combined with immune therapy by including the targeted nanoparticles conjugated with immune stimulators, such as modified viral particles or modified plant viral viruses, along with the nanoparticles etc. to induce an immune response to the tumor cells, disease process, Alzheimer's plaques, etc.

In one embodiment, imaging is combined with nanoparticle assisted photoacoustic imaging, OCT, OCTA, FA, focused ultrasound, non-focused ultrasound, MRI, PET scan, CT scan, surface enhanced Raman spectroscopy and imaging, which enhances the molecular diagnosis of a substance attached to the surface of a metallic nanoparticle after it is exposed to the laser light energy as known in the art, etc. recorded to enhance an early disease diagnosis in vivo.

In one embodiment, one can deliver antibiotics, anti-parasitic drugs, anti-fungal drugs, anti-viral drugs anti-inflammatory agents, etc. conjugated with the quantum dot nanoparticles.

The embodiments shown and described in the specification are only specific embodiments of inventors who are skilled in the art and are not limiting in any way to the location in the body, nanoparticle type or composition, disease process, source of energy, medication, gene, etc. Therefore, various changes, modifications, or alterations to those embodiments may be made without departing from the spirit of the invention in the scope of the following claims. The references cited are expressly incorporated by reference herein in their entirety. 

What is claimed is:
 1. A method for early detection of a pathology in a patient, the method comprising imaging at least one biomarker, metabolite, and/or early stage cell or extracellular vesicle in a retinal vessel in the patient, where the imaging comprises administering a pathology specific or non-specific antibody-coated nanoparticle into a circulation, exciting the antibody-coated nanoparticle with an energy source to elicit a response from the circulating antibody-coated nanoparticle, and detecting and quantifying the response, where if the biomarker is present reporting detection of the pathology indicated by the biomarker. 2-4. (canceled)
 5. The method of claim 1 further comprising diagnosing a malignant tumor prior to the malignant tumor having reached a size up to 3 mm in diameter.
 6. The method of claim 1 further comprising differentiating between a malignant tumor and a benign tumor.
 7. (canceled)
 8. The method of claim 1 where the pathology is selected from the group consisting of cancer, an infection, an inflammation, a metabolic disorder, a genetic disease, a neurodegenerative disease, an ocular disease, and combinations thereof.
 9. The method of claim 1 further comprising injecting into the patient's circulation an antibody coated nanoparticle quantum dot, where the antibody targets a corresponding antigen, where the antigen is at least one of a receptor on a tumor cell membrane, a protein in a blood vessel wall, a sessile tumor, a free circulating tumor cell, an ECV, an infective agent, or an exosome; allowing the antibody-coated nanoparticle quantum dot to adhere to cells; then, after nanoparticle targeting and adhering, applying thermal energy to the antibody-coated nanoparticle adhered to cells and receiving a photoacoustic sound from the heated antibody-coated nanoparticle adhered to the cells to image a lesion and/or circulating cells.
 10. The method of claim 1 where the antibody to the antigen is lesion- or tumor-specific or lesion- or tumor-non-specific.
 11. The method of claim 9 where the nanoparticle has a size ranging from 1 nm-8 nm, 8 nm-20 nm, 20 nm-50 nm, 50 nm-100 nm, 100 nm-500 nm, or 500 nm-900 nm.
 12. The method of claim 9 where the antibody-coated nanoparticle quantum dot is specific for at least one biomarker for a lesion, tumor, tumor type, or tumor set.
 13. (canceled)
 14. The method of claim 9 where the site is vessel wall having a defect, further comprising, after targeting and binding, applying at least one of low dose thermal radiation, x-ray radiation, continuous laser pulses, or laser pulses alone or in the presence of a photosensitizer causing a photodynamic effect resulting in free radicals, damage to the vessel wall, platelet aggregation and occlusion of the vessel.
 15. The method of claim 14 combined with local delivery of an antibody and thermosensitive polymer drug conjugated nanoparticle to the site that treats the disease process or enhances the photodynamic effect.
 16. The method of claim 9 further comprising sizing the antibody-coated nanoparticle quantum dot adhered to cells, where the size or composition of the antibody-coated nanoparticle quantum dot adhered to cells distinguishes a tumor cell from a non-tumor element.
 17. The method of claim 9 where the antibody-coated nanoparticle quantum dot upon stimulation, emits light of a specific wavelength that is detectable by a method selected from the group consisting of fundus photography, nanoparticle assisted angiography, optical coherence tomography (OCT), OCT angiography (OCTA), and combinations thereof, the emitted light providing information on the origin of the cells to which the antibody-coated nanoparticle quantum dot adhered.
 18. The method of claim 17 further comprising detecting and recording the emitted specific wavelength of light to determine the presence of a specific tumor cell and/or ECV in retinal circulation, choroidal circulation, or diseased induced cystic spaces of the retina, choroid, superficial vessels, and combinations thereof.
 19. The method of claim 17 where the emitted specific wavelength of light is diagnostic for a pathological cell or an organism.
 20. The method of claim 17 where the emitted wavelength of light differentiates the antibody-coated nanoparticle quantum dot adhered to cells by size and/or by composition, the antibody coating comprising a specific antibody, the emitted wavelength of light further differentiating the antibody-coated nanoparticle quantum dot bound to a cell containing the specific cell antigen to the antibody-coated nanoparticle quantum dot bound to an extracellular vesicle membrane antigen.
 21. The method of claim 20 where the cell is a sessile cell, a circulating cell, an ECV, or combinations thereof.
 22. The method of claim 20 where the antibody-coated nanoparticle quantum dot adhered to cells is used to determine a cell feature selected from the group consisting of cell presence, cell origin, cell location, cell quantity, and combinations thereof by tracking and visualizing the nanoparticles.
 23. The method of claim 9 further comprising irradiating the retina to increase the temperature of the circulating nanoparticles in the retinal and choroidal circulation, applying photoacoustic imaging technology to obtain a photoacoustic spectroscopy of the antibody-coated nanoparticles attached to free floating cells or exosomes, imaging the free floating cells or exosomes, and evaluating the image to diagnose a lesion and/or quantify the free floating cell or exosome.
 24. The method of claim 23 where the radiation is selected from the group consisting of focused electromagnetic radiation, focused low dose microwave radiation, focused radiofrequency radiation, focused laser radiation, focused ultrasound, and combinations thereof.
 25. The method of claim 23 further comprising irradiating the retina using a laser focused on a specific retinal vessel non-invasively or through a contact lens positioned on the cornea of the patient and where an operator under observation maintains the laser beam lens on a retinal vessel while the retina is under observation through a slit lamp microscope, a camera adjusts the photoacoustic imaging system connected to the thermal energy delivery source via a computer to achieve a thermoacoustic response of about 41° C. to 45° C. from the heated nanoparticles, images a photoacoustic sound wave from the heated nanoparticles' thermal expansion, where a circulating nanoparticle-cell complex and/or nanoparticle-ECV complex in the retinal vessel is evaluated from the image.
 26. The method of claim 25 where an ultrasound receiver of the photoacoustic imaging technology system is attached to a site selected from the group consisting of a side of the eye, a lid of the eye, or a forehead proximal to the eye.
 27. The method of claim 1 where the pathology is at a site selected from the group consisting of retina, choroid, skin, mucosa, and combinations thereof.
 28. The method of claim 25 where the results provide lesion information selected from the group consisting to nature, type, origin, infection, and combinations thereof.
 29. (canceled)
 30. The method of claim 29 where an image provides information about an ocular structure selected from the group consisting of anterior segment, lens, retina, retinal vessel, conjunctival vessel, anterior choroid, and combinations thereof.
 31. The method of claim 29 where an image provides information about skin selected from the group consisting of a skin disorder, a skin lesion type, a skin lesion thickness, a skin lesion border, and combinations thereof.
 32. The method of claim 17 where the light of a specific wavelength is detected by nanoparticle assisted OCTA and at least one of a two-dimensional and a three dimensional image of the antibody coated nanoparticle quantum dot is provided.
 33. The method of claim 32 where imaging is of a site selected from the group consisting of retinal vessels, choroidal vessels, conjunctival vessels, vascular abnormalities, retinal neovascularations, choroidal neovascularizations, and combinations thereof.
 34. The method of claim 17 where imaging is by nanoparticle assisted fluorescent angiography (FA) and the abnormality is selected from the group consisting of abnormal lesions, neovascular lesions, a vessel defect, a vessel wall defect in retinal pigment epithelium, a vessel abnormality, and combinations thereof.
 35. The method of claim 34 where abnormal vessels or new vessels result from hypoxia causing adjacent tissues to produce vascular endothelial growth factor (VEGF) inducing neovascularization, inflammatory diseases directly affect the blood retinal barrier, cause leakage of fluorescent outside the vasculature.
 36. The method of claim 34 where the vessel defect detected is selected from the group consisting of an inflammatory process, a hypoxia induced defect, an occlusion, and combinations thereof.
 37. The method of claim 34 where the antibody coated nanoparticle quantum dots fluoresce and fluorescence is passed, without being scattered by the transparent retinal tissue, through an appropriate barrier filter and photographed or videoed by a camera.
 38. The method of claim 34 where the light source that excites the nanoparticles also produce a nanoparticle assisted OCT or an OCTA that is recorded separately by an OCT unit and the light is separated from the OCT unit by a barrier filter diverted to be imaged by an angiographic camera separately, creating a combined OCT, OCTA, and nanoparticle assisted fluorescent angiogram system.
 39. The method of claim 38 where an infrared (IR) light source excites the nanoparticles.
 40. The method of claim 39 further comprising an IR wavelength and a near-IR excitation and the nanoparticles have a size ranging from 1 nm up to 150 nm and nanoparticles are selected from the group consisting of a lanthanide family, a lanthanide rich composite, and combinations thereof having an emission in a visible wavelength.
 41. The method of claim 40 where the lanthanide family member is selected from the group consisting of functionalized nanoparticles of erbium, thulium, holium Ln, Ti, Ni, Mo, Re, Os, Cerium, lanthnum, lutetium, yttrium, scandium, gadolinium fluoride, and lanthnum fluoride; and where the lanthanide rich composite is selected from the group consisting of Ce, Nd, ER, etc. in combination with an anion from a halide, phosphate, vanadate group, or LaAL0ri3/SrTiO3, thulium-doped silica, gadelonium or neodynium complexes such as Nd—Fe—B, or semiconductors CdSe, PbSe, PbS.
 42. The method of claim 40 where the nanoparticles upconvert the excitation light and convert two IR photons to a single visible light that can be photographed with a standard fundus camera or permit video-angiography in the absence dyes selected from the group consisting of fluoresceine or indocyanin green.
 43. The method of claim 1 where the antibody coated nanoparticle contains an additional coating.
 44. The method of claim 43 where the additional coating is selected from the group consisting of a polymer, a thermosensitive polymer, chitosan, a cell penetrating agent, a part of a biotin/streptavadin binding pair, an antibody, an antigen, or combinations thereof.
 45. The method of claim 43 where the nanoparticles are coated with an anti-cytokine antibody that, upon injection into a patient, attach to cytokine producing cells and localize to an ischemic site.
 46. The method of claim 45 where the nanoparticles further comprise a gene that inhibits production of VEGF and/or cell proliferation.
 47. The method of claim 1 for detecting inflammatory biomarkers in a specific tissue or site.
 48. The method of claim 47 where the tissue or site is selected from the group consisting of a pathology, an infarct, a disease, an infectious site, a site of an autoimmune response, a genetic disorder, a tumor, and combinations thereof, and where the site is imaged by a method selected from the group consisting of X-rays, magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET), ultrasound, focused ultrasound, SERS, and combinations thereof.
 49. The method of claim 43 where the nanoparticle is coated with a thermosensitive polymer and conjugated with an anti-VEGF antibody that attaches to vascular endothelial cells producing VEGF receptors to image and treat abnormal vessels during a procedure using a radiation source selected from the group consisting of a microwave, radiofrequency wave, focused ultrasound wave, and combinations thereof.
 50. The method of claim 39 where the IR radiation simultaneously provides a nanoparticle quantum dot assisted OCTA image of the retina provides a nanoparticle-assisted angiogram imposable on the OCTA or the OCT to show the exact location of the nanoparticle.
 51. The method of claim 39 where subretinal fluid in vessels, cysts, or cavities is visualized with nanoparticles with a size ranging from 1 nm-8 nm that pass through small breaks of retinal vessels or retinal pigment epithelium be visualized during angiography.
 52. The method of claim 1 where emitted light from the quantum dot nanoparticles is used to image non-surface structures, an optic nerve head, a structure in the posterior choroidal circulation without interference with incoming invisible IR light.
 53. The method of claim 52 where the nanoparticles are plasmonic nanoparticles or functionalized lanthanide series-coated nanoparticles.
 54. The method of claim 44 where a photosensitizer is conjugated with a thermosensitive coating of the antibody-coated nanoparticle and, upon light activation, the antibody-coated nanoparticle simultaneously releases a portion of the photosensitizer, heats abnormal cells, and damages an abnormal vessel wall which closes after release of the photosensitizer which, in the presence of oxygen and laser application, creates singlet oxygen and free radicals causing platelet aggregation that closes abnormal vessels without damaging normal adjacent tissue or creating a systemic response to the photosensitizer.
 55. The method of claim 54 where the photosensitizer conjugated with the antibody-coated nanoparticle is administered by intravenous injection without producing side effects from the photosensitizer intravenous injection.
 56. The method of claim 51 where the circulating antibody coated quantum dot nanoparticle informs a disease location and degree of damage.
 57. The method of claim 9 where the antibody coated nanoparticle is conjugated to a gene that can modify the genetic composition of the cells to which the nanoparticles are targeted. 58-59. (canceled)
 60. The method of claim 9 where the nanoparticles further comprise an anticancer agent, and the method further comprising applying repeated non-coagulative laser pulses for about 10 min-15 min controlled by a photoacoustic system using an externally located laser or a fiber optic to a tumor to increase a temperature of the tumor to 42° C. to 43° C. to depolarize the tumor cell, release the anticancer agent to the tumor cell, render the tumor cell membrane permeable to the anticancer agent that is released from the thermosensitive coating of the nanoparticle to freely diffuse the anti-cancer agent in the tumor cells to damage the tumor cells.
 61. The method of claim 60 where the tumor is a glioblastoma, a retinoblastoma, a medulloblastoma, an acoustic neuroma, a spinal cord tumor, a peripheral nerve tumor, a choroidal melanoma, a skin melanoma, a mesenchymal cell tumor, a tumor of ectodermal origin, a basal cell carcinoma, a squamous cancer, and combinations thereof.
 62. (canceled)
 63. The method of claim 60 where the anticancer agent is selected from the group consisting of melphalan, allovectin-7, decarbazine, 5-fluorouracil, mechlorethamine, cyclophosphamide, melphalan, chlorambucil, ifosfamide, busulfan, N-nitroso-N-methylurea (MNU), carmustine (BCNU), lomustine (CCNU), semustine (MeCCNU), fotemustine, streptozotocin, dacarbazine, mitozolomide, temozolomide, thiotepa, mytomycin, diaziquone (AZQ), cisplatin, carboplatin, oxaliplatin, procarbazine, hexamethylmelamine, methotrexate, pemetrexed, fluorouracil, capecitabine, cytarabine, gemcitabine, decitabine, azacitidine, fludarabine, nelarabine, cladribine, clofarabine, pentostatin, thioguanine, mercaptopurine, vincristine, vinblastine, vinorelbine, vindesine, vinflunine, paclitaxel, docetaxel, irinotecan, topotecan, etoposide, doxorubicin, mitoxantrone, teniposide, novobiocin, merbarone, aclarubicin, actinomycin, bleomycin, plicamycin, mitomycin, doxorubicin, daunorubicin, epirubicin, idarubicin, pirarubicin, aclarubicin, mitoxantrone, and combinations thereof.
 64. (canceled)
 65. The method of claim 44 where the nanoparticles are heated to about 43° C. to heat and damage tumor cells by oscillating thermotherapy under control of a photoacoustic system.
 66. A recognition method for an early stage of a neoplastic process without producing a clinical symptom in a patient, the method comprising defining a change in a tissue of a patient, the change indicating an early stage lesion or disease process in at least one cell in the tissue, administering a plurality of nanoparticles to the patient, the nanoparticles bound to an antibody against a protein in the lesion to result in functionalized nanoparticles, the functionalized nanoparticles optionally coated with a thermosensitive polymer containing a medicament for therapy of the lesion, interrogating the cellular and extracellular vesicles in the patient's blood using a photoacoustic spectroscopic system and an optical spectroscopic fundus camera equipped with a laser that is focused on a retinal vessel of the patient, recording, imaging, quantifying, and/or analyzing the patient's cells and extracellular vesicles according to the antibody-coated nanoparticles, and using the system to increase temperature of the nanoparticles optionally coated with a thermosensitive polymer under control of the photoacoustic system to a temperature of 42° C. to 43° C. to release the medicament to treat the lesion.
 67. The method of claim 66 further comprising exposing the nanoparticles to a thermal energy source from a thermal energy delivery unit controlled by the photoacoustic spectroscopic system to increase the temperature in the nanoparticle, resulting in a photoacoustic sound that is recorded by the photoacoustic system, the method combining photoacoustic imaging to verify and image the location of the early stage lesion or process.
 68. The method of claim 67 where the photoacoustic spectroscopic system controls the amount of thermal energy to maintain an system operator desired temperature ranging from 38° C. to 45° C.
 69. The method of claim 66 where the nanoparticles are selected from the group consisting of quantum dots, organic, inorganic, synthetic, magnetic, paramagnetic, non-magnetic, nano/microbubble, piezoelectric, shell structure, cage structure, wire structure, tube structure, spherical, cylindroid, tube, multi-faceted, gold, silica, iron, iron oxide, zinc, zinc oxide or their composites, cadmium sulfate, lanthanide, upconverting nanoparticles, copper core or surface, nickel core or surface, carbon core or surface, graphene core or surface, radioactive surface, and combinations thereof.
 70. The method of claim 66 further comprising treating the lesion with thermal energy at a temperature ranging from 38° C. to 45° C. to a radioactive-coated quantum dot nanoparticle.
 71. The method of claim 70 further comprising imaging the location of and treating the lesion.
 72. The method of claim 66 where the early stage lesion is selected from the group consisting of an inflammatory process, an infective process, a neovascular process, a vascular occlusive process, a tumorigenic process, a neurological process, and combinations thereof.
 73. (canceled)
 74. The method of claim 66 further comprising applying to the site of the lesion a therapy selected from the group consisting of precision thermotherapy, drug delivery, gene delivery, anti-inflammatory therapy, anti-cancer therapy, and combinations thereof. 75-77. (canceled)
 78. The method of claim 74 where the nanoparticle is conjugated with an immune checkpoint inhibitor to facilitate leukocyte mediated tumor destruction.
 79. The method of claim 1 further comprising analyzing a blood sample from the patient for a component selected from the group consisting of a biomarker, a tumor protein, a microDNA, a microRNA, an enzyme, a nucleosome, an extracellular vesicle, a free floating tumor cell, a biomolecule, and combinations thereof.
 80. The method of claim 1 where the imaging uses a method selected from the group consisting of antibody coated nanoparticle assisted photoacoustic technology, ultrasound, surface enhanced Raman spectroscopy, nanoparticle assisted fluorescence angiography, photography, computed tomography, magnetic resonance imaging, and combinations thereof. 